The American Society of Clinical Oncology (ASCO) Annual Meeting is here! From June 3 to June 7, more than 30,000 oncology professionals from around the world will meet to discuss the latest research in state-of-the-art treatments, new therapies, and patient care.
The theme for this year’s meeting is Collective Wisdom: The Future of Patient-Centered Care and Research. According to ASCO President Julie M. Vose, MD, MBA, FASCO, “the patient is at the center of a very complex system trying to assist them through their journey of cancer care. I selected the theme of collective wisdom to represent the importance of the multimodality care that is necessary for our patients.”
It’s easy to get caught up in the excitement surrounding new treatments. But, cancer research is more than exploring new treatment options. An important part of patient-centered care involves finding the best ways to get patients the care they need and to make sure they have the highest quality of life possible. These studies offer a glimpse into how the research community constantly strives to make sure that treatments help everyone in need.
Read below to learn about the research released today:
Web-based follow-up application helps patients with lung cancer live longer
Black women with BRCA gene changes are less likely to receive preventive surgery
Cancer drug affordability is a worldwide issue
Aggressive cancer treatment at the end of life. When is it right?
Vice President Joe Biden to Speak at 2016 ASCO Annual Meeting Special Session
ASCO is pleased to announce that Vice President Joe Biden will deliver remarks during the ASCO Annual Meeting on Monday, June 6, at 3 PM US Central time in Hall B1. Vice President Biden will discuss the Cancer Moonshot Initiative—his ambitious project to double the pace of progress against cancer in coming years. Since the Moonshot initiative launched in January, ASCO has worked with the Vice President to support and offer guidance. The event will be open to all meeting attendees and will be streamed online. Learn more.
Researchers in France studied using a web-based application that allowed patients with stage III or stage IV lung cancer to report their symptoms to their doctors. They compared this with the current standard, which relies on regularly scheduled doctor visits and CT scans. Patients with this high-risk disease are more likely to have it come back or recur. According to the researchers, most people whose lung cancer recurs experience symptoms.
Patients or their caregivers used the web application to record their symptoms every week. The application would look for specific changes in symptoms and alert doctors if a new office visit or scan needed to be scheduled. With this approach, doctors hoped to find and treat a relapse earlier.
After 1 year, 75% of the patients in the web-application group were still alive, compared with 49% in the standard follow-up group. The median overall survival for patients who used the application was 19 months; for patients in standard follow-up, overall survival was 12 months. The median is the midpoint, which means that half of patients lived longer and half lived for a shorter time. Recurrence was equally common between the 2 study groups (51% and 49%), but patients who used the application were in better health. Of those who needed treatment, 74% were able to receive the full course. Of those receiving standard follow-up care who experienced a recurrence, just 33% were able to receive full treatment. Patients who used the application also reported a better quality of life and had half as many scans as those receiving standard follow-up care.
What does this mean? By using this web application, patients were able to spend less time going to office visits and experienced a better quality of life. They also improved their chances of having a recurrence identified early, which could help them live longer. It took doctors 15 minutes to review information from 60 patients. And, the automated process meant that fewer patients needed to call their doctors.
“Through personalized follow-up using this convenient and simple online application, we can detect complications and signs of relapse and offer appropriate care earlier.“
—lead study author Fabrice Denis, MD, PhD, Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
In a study of breast cancer survivors across Florida, researchers found that black women were less likely to receive recommended genetic testing and preventive treatments than white or Hispanic women. The survivors in this study all carried a mutation in the BRCA gene, which is linked to higher risk of breast and ovarian cancer. If a woman with a BRCA mutation is diagnosed with breast cancer, she also faces up to a 50% risk of a second breast cancer and as much as a 44% risk of ovarian cancer. There are 2 recommended forms of preventive treatment that can dramatically reduce the risk of later cancer for women with such a high risk:
Mastectomy, which is removal of the entire breast
Oophorectomy, which is removal of the ovaries and fallopian tubes
Among the 3 racial groups, black women had the lowest rates of mastectomy (68%) and oophorectomy (32%). Among white and Hispanic women, these rates were 94% and 85% for mastectomy, respectively, and 71% and 85% for oophorectomy, respectively. These differences were even seen in the rates of genetic testing for the BRCA mutation. Only 36% of black women received testing, whereas 65% of white women and 62% of Hispanic women did.
What does this mean? This study included patients from diverse settings across all of Florida, not just from a single academic center or health system. Therefore, the study authors feel that their results are representative of the general population of Florida. The researchers do not know precisely why these women are receiving less treatment. For example, it may be that receiving a breast cancer diagnosis is so painful that women choose to treat their breast cancer first and worry about ovarian cancer risk later. Another possible explanation for these results is that there were very few women in this study: 51 white, 28 black (4 of whom were still being treated ), and 12 Hispanic. Patricia Ganz, MD, ASCO Expert in breast cancer, notes that “it’s important that all women and their physicians have that discussion about the benefits and risks, no matter their race.”
“I hope that our findings will raise awareness of disparities pertaining to inherited cancer predisposition that exist across the cancer care continuum. It is now imperative to understand why these disparities exist, so we can develop interventions to address them to ensure that women with inherited disease make informed decisions about their cancer risk management.”
—lead study author Tuya Pal, MD, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
There is a lot of anecdotal news about the differences in costs of cancer drugs between countries. However, there is little actual research to support claims about drug prices. In this study, researchers looked at differences in median retail prices for 23 cancer drugs in 7 countries to compare affordability. The median is the midpoint, which means that half of the countries had higher retail prices and half had lower retail prices.
The researchers based their drug prices on retail prices found on government websites. To measure affordability, they used a measure of national wealth that accounts for the cost of living called GDPcapPPP, which is available from the International Monetary Fund. In this study, the lower the percentage of GDPcapPPP for the monthly cost of a cancer drug, the more affordable it is.
Median prices for brand-name drugs ranged from $1,515 per month in India to $8,694 per month in the United States. For generic drugs, median monthly prices were lowest in South Africa ($120) and India ($159) and highest in the United States ($654).
However, in terms of a person’s ability to pay for the drug, Australia appeared to be the most affordable. There, monthly generic drugs were 3% of GDPcapPPP and 71% for brand-name drugs. In the United States, the monthly cost of generics was 14% of GDPcapPPP and the monthly cost of brand-name drugs was 192%. The least affordable countries were China and India. In China, generics were 48% of GDPcapPPP and brand-name drugs were 288%. In India, generics were 33% of GDPcapPPP and brand-name drugs were 313%.
What does this mean? This study showed that even though cancer drugs may cost less in low-income countries, the drugs are less affordable than they are in countries like the United States or United Kingdom. Drugs are rarely paid for at retail price, however, so more studies are needed to examine patients’ ability to pay for their medications.
“This study provides a glimpse into prices and affordability of cancer drugs around the world and sets the stage for further research. However, the implications of our findings are limited because we were not able to take discounts and rebates into account, which would better predict drug affordability.”
—lead study author Daniel A. Goldstein, MD, Rabin Medical Center, Petach Tkvah, Israel
In 2012, ASCO’s Choosing Wisely® recommendations advised against giving patients treatments that slow, stop, or eliminate cancer when it is unlikely that the patient will benefit from the treatment. Instead, these patients should receive palliative care to make the end of life as comfortable and pain-free as possible. This study set out to see if patients were still receiving aggressive treatment at the end of life in the 3 years since the recommendations were released.
Researchers analyzed information from health insurance claims from more than 28,000 patients in 14 states across the United States. These patients were younger than 65 years old when they died and had been diagnosed with metastatic lung, colorectal, breast, pancreatic, or prostate cancer. The researchers wanted to see how many of these patients received aggressive care in the last 30 days of their lives. For the purposes of this study, “aggressive care” included:
Invasive medical procedures, such as biopsy, radiation therapy, and chemotherapy
Admission to the hospital or an emergency department visit
Intensive care admissions
Dying in the hospital
The results of the study showed that the recommendations had little effect on how many dying patients received aggressive care. Most patients (62% to 65%) were admitted to the hospital or visited the emergency department in their last 30 days of life. About 1 of every 3 patients died in the hospital instead of at home. Less than 20% of patients went into hospice care.
What does this mean? Patients and their caregivers need to be informed about their options when it comes to the end of life and communicate their wishes to their health care team. Open communication between patients and doctors can help prioritize a patient’s quality of life and temper expectations.
“While it can be difficult to predict when a patient is nearing his or her final month of life, we need to do a better job of scaling back treatment and connecting patients with palliative care sooner. Intensive care at the end of life remains appropriate for some patients. Still, we need more education of both patients and physicians to improve conversations about goals and expectations.”
—lead study author Ronald C. Chen, MD, MPH, University of North Carolina, Chapel Hill, NC
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